The effect of cognitive-behavioral therapy on distress management among head and neck cancer patients undergoing surgery at a tertiary care center in Eastern India.

Abstract

Background: A diagnosis of cancer increases susceptibility to stress; thus, cancer patients are at high risk for a variety of emotional disorders, including anxiety, traumatic stress, and depression. Psychological distress may have multiple negative impacts on health outcomes. Surgical cancer patients are at an increased risk of cancer-related fatigue and psychological distress. Studies in the West have shown that there is a 40%-80% reduction in cancer-related distress if the patients are subjected to appropriate psycho-oncological interventions.

Objectives: The aims of this study were to 1) screen head and neck cancer patients for distress by using a cancer-specific questionnaire, 2) to test the association of cancer-related distress with the sociodemographic characteristics of patients, and 3) to evaluate the effect of cognitive-behavioral therapy (CBT) on the distress level of head and neck cancer patients about to undergo surgery.

Methods and materials: A pre-tested, semi-structured, self-administered 23-item Questionnaire on Stress in Cancer patients (QSC-R23) were used to measure the level of distress. Three sessions of CBT of 1-hour duration on every alternate day were given to elicit the response. Categorical data were analyzed using the Chi-square test. Paired sample t test was applied to compare the pre and post scores. The correlation was done to compare continuous variables by using Pearson's correlation test. Linear regression analysis was performed to elicit the effect of other associated variables.

Results: The mean age of the 94 participants was 54.64 (±10.97) years. The mean pre-score was 60.06 (±20.42), and the mean post-score was 34.63 (±5.3). There was a significant improvement in the post-score (P = 0.0001), implying a reduction in stress among the study participants after the three sessions of CBT. Participants with middle/high monthly family income (P = 0.35, 95% CI = 0.639-17.418), with no past medical history (P = 0.35, 95% CI = 0.639-17.418) and no past psychiatric history (P = 0.005, 95% CI = 3.621-20.162) were more likely to benefit from the intervention.

Conclusion: Owing to the lack of supportive literature from India, it is assumed that the prevalence rates of cancer-related distress in patients may be underestimated, resulting in a lack of availability of suitable intervention(s). However, this study has successfully reported that CBT can reduce the distress levels among cancer patients. However, there is still a need to explore this research and produce more relevant evidence-based literature.